Stop the Suffering Among Older Patients
By RWJF Executive Nurse Fellows alumna Keela Herr, PhD, RN, FAAN, Professor and Associate Dean for Faculty, The University of Iowa College of Nursing, Co-Director, Iowa John A. Hartford Center of Geriatric Nursing Excellence
A recent article in the New York Times highlighted an important study by Tim Platts-Mills, MD, and his colleagues that examined pain treatment of older adults in emergency departments across the country. They found that people over age 75 are about 20 percent less likely to have their pain treated than are middle-aged patients. More importantly, the researchers found that in the over-75 group, only 53 percent of those who reported pain received an analgesic or a prescription for one. In patients with severe pain, only 65 percent received an analgesic.
These findings indicate that we still have a lot of work to do to address the under-treatment of pain in older people. The findings contribute to data collected in other care settings (such as hospitals, nursing homes and hospices) that also show inadequate treatment of pain in older people.
Attention was first drawn to the problem in the early 1990s, and researchers and clinicians have since contributed knowledge to guide provider practices to improve pain care. Yet, here we are 20 years later, and the picture hasn’t improved much.
Many organizations and groups (such as the International Association for the Study of Pain, the American Pain Society, the American Society for Pain Management Nursing, the American Geriatric Society, and the American Pain Foundation) are committed to quality pain care for all people. These groups work to raise awareness, provide education and resources, develop clinical practice guidelines and advocate for research and policies that support good care.
The National Institute on Aging, the National Institutes of Health Pain Consortium and the U.S. Food and Drug Administration held panel discussions in 2010 to identify strategies for promoting safe pharmacological management of pain in older people. These discussions led to a research agenda and strategies to support providers in clinical decision-making.
Another example of work to improve pain care in older persons is the development of GeriatricPain.org, an online resource that provides best practice resources and tools for addressing pain in nursing home residents. This work was done by a committed group of geriatric nursing pain experts and was funded by The Mayday Fund and completed under the auspices of my fellowship as a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow.
We now have clinical guidelines and resources to guide practice, but we need more research to guide pain care for older people. To be sure, pain treatment in older adults must be provided with caution. But there are safe methods for managing pain in this population. To ensure adequate pain care for older people, providers must appropriately assess and evaluate patients; carefully select medications, dosing and titration levels; incorporate nondrug approaches; and regularly monitor patients to determine the effectiveness of treatments and watch for the development of adverse effects.
Our biggest challenge, however, is determining how to move evidence-based practice recommendations into consistent clinical use in all settings of care so our seniors don’t suffer from unnecessary pain and related conditions.
Read more about Keela Herr’s work.